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185716 05/26/2010
CITY OF CARMEL, INDIANA VENDOR: 363750 Page 1 of 1 ONE CIVIC SQUARE ERMCO INC CARMEL, INDIANA 46032 PO BOX 1507 CHECK AMOUNT: $309,036.40 INDIANAPOLIS IN 46206 CHECK NUMBER: 185716 CHECK DATE: 5/2612010 DEPARTMENT ACCOUNT PO NUMBER INVOICE NUMBER AMOUNT DESCRIPTION 902 4460807 APP 23 309,036.40 PERFORMING ARTS CENTE J 7 Document G7021CMa 992 Application and Certificate` for Payment Construction Manager- Adviser Edition TO OWNER: Carmel Redevelopment Commisf%eJECT: Parcel 7A, Regional Performing ArtsAPPLICATION NO 23` Distribution to: 1 Civic Square Center Interior Rough PERIOD TO: 3/31%2010 OWNER El Carmel, IN 46032 Construction Package P4 CONSTRUCTION MANAGER FROM CO NT PgRb INC. VIA CONSTRUCTION MANAGER: CONTRACT DATE: ARCHITECT P.O. Box 1507 Shiel Sexton PROJECT NOS: 26954320 1 CONTRACTOR Indianapolis, IN 46206 VIA ARCHITECT: FIELD CSO Architects CONTRACT F@I%Ctrical Installation Proiect 25310H El CONTRACTOR'S APPLICATION FOR PAYMENT- The undersi Contractor certifies that to the best of the Contractor's knowled information and Application is made for payment, as shown below, in connection with the Contract. belief the Work covered by this Application for Payment has been completed in accordance with the Continuation Sheet, AIA Document G703, is attached. Contract Documents, that all amounts have been paid by the Contractor for Work for which previous Certificates for Payment were issued and payments received from the Owner, and that current 1. ORIGINAL CONTRACT SUM payment shown herein is now due. 2. Net change by Change Orders (437,622.00) CONTRACTOR? EERMCO, I 3. CONTRACT SUM TO DATE (Line 1 2) 7r 067,378.00 By: %T'U Date: 3/15/2010 4. TOTAL COMPLETED STORED TO DATE Column G on G703 5 ,965,820.56 State of: Indiana 5: RETAlNAGE; County of: Marion a• of Completed Work Subscribed and sworn to before (Column D.+ E on G703) 353,3§ me this 15th day of h, 2010 b. of Stored Material Notary Public: Y (Column F on G703) My Commission expires: 1 2/1 )/2015 Total Retainage (Lines 5a 5b or Total in Column I of G703)., 353 ,368.90 CERTIFICATE FOR PAYMENT 5,612,451.66 In accordance with the Contract Documents, based on on -site observations and the data comprising 6. TOTAL EARNED LESS RETAINAGE this application, the Construction Manager and Architect certify to the Owner that to the best of their (Line 4 Less Line 5 Total) knowledge, information and belief the Work has progressed as indicated, the quality of the Work is in 7. LESS PREVIOUS CERTIFICATES FOR PAYMENT 5,303,415.26 accordance with the Contract. Documents, and the Contractor is entitled to payment of the AMOUNT (Line .6 from prior Certificate) CERTIFIED. 8. CURRENT PAY_ MENT DUE I s 309,036.40 'AMOUNT CERTIFIED 9. BALANCE TO FINISH, INCLUDING RETAINAGE (Attach explmTation if amount certified differs fro amount, applied. Initial all figures on this Application and on e Continuation Sh that ,e ch rigid to conform with the amount certified.) Line 3 less Line 6 1,454 92 6.34 CONST UCTION MA By: Date: 9 ADDITIONS DEDUCTIONS CHANGE ORDER SUMMARY ARCHI Total changes approved it previous months by Owner 71, 499.00 509,121.00 By: Date: Total approved his'Month This Certificate is not negotiable. The AMOUNT CERTIFIED is payable only o the Contractor TOTALS 499.00 X509,121.00) named herein. Issuance payment and acceptance of payment are without prejudice to any rights of NET CHANGES by Change Order (437,622.00) the Owner or Contractor under this Contract. CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G702 /cMaTM 1992. Copyright 1992 by The American institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIO Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted'to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. S TM Document G702/CMa -1992 Instructions Application and Certificate for Payment Construction Manager Adviser Edition A. General Information AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager- Adviser Edition, is to be used in conjunction with AIA Document G703, Continuation Sheet. These documents are designed to be used on a Project where a Construction Manager is employed as an adviser to the Owner, but not as a constructor, and where multiple Contractors have direct Agreements with the Owner. Procedures for their use are covered in AIA Document A201 /CMa, General Conditions of the Contract for Construction, Construction Manager- Adviser Edition, 1992 Edition. B. Reproductions This document is a copyrighted work and may not be reproduced or excerpted from without the express written permission of the AIA. There is no implied permission to reproduce this document, nor does membership in The American Institute of Architects confer any further rights to reproduce this document. The AIA hereby grants the purchaser a limited license to reproduce a maximum of ten copies of a completed G702 /CMa, but only for use in connection with a particular project. The AIA will not permit reproduction outside of the limited license for reproduction granted above, except upon written request and receipt of written permission from the AIA. Rights to reproduce the document may vary for users of AIA software. Licensed AIA software users should consult the End User License Agreement (EULA). To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. C. Completing the G7021CMa Form After the Contractor has completed AIA Document G703, Continuation Sheet, summary information should be transferred to AIA Document G702 /CMa, Application and Certificate for Payment, Construction Manager Adviser Edition. The Contractor should sign G702/CMa, have it notarized and submit it, together with G703, to the Construction Manager and Architect. The Construction Manager and Architect should review G702 /CMa and G703 and, if they are acceptable, complete the Certificate for Payment on G702 /CMa. The Construction Manager and Architect may certify a different amount than that applied for pursuant to Sections 9.5 and 9.6 of A201 /CMa. They should then initial all figures on G702/CMa and G703 that have been changed to conform to the amount certified and attach an explanation. The completed G702 /CMa and G703 should be forwarded to the Owner. D. Completing the G703 Form Heading: This information should be completed to be consistent with similar information on AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager Adviser Edition. Columns A, B C: These columns should be completed by identifying the various portions of the Project and their scheduled value consistent with the schedule of values submitted to the Architect at the commencement of the Project or as subsequently adjusted. The breakdown may be by sections of the Work or by Subcontractors and should remain consistent throughout the Project. Multiple pages should be used when required. Column C should be subtotaled at the bottom when more than one page is used and totaled on the last page. Initially, this total should equal the original Contract Sum. The total of column C may be adjusted by Change Orders during the Project. Column D: Enter in this column the amount of completed work covered by the previous application (columns D E from the previous application). Values from column F (Materials Presently Stored) from the previous application should not be entered in this column. Column E: Enter here the value of Work completed at the time of this application, including the value of materials incorporated into the project which were listed on the previous application under Materials Presently Stored (column F). Column F: Enter here the value of Materials Presently Stored for which payment is sought. The total of the column must be recalculated at the end of each pay period. This value covers both materials newly stored for which payment is sought and materials previously stored which are not yet incorporated into the Project. Mere payment by the Owner for stored materials does not result in a deduction from this column. Only as materials are incorporated into the Project is their value deducted from this column and Incorporated into column E (Work Completed This Period). Column G: Enter here the total of columns D, E and F. Calculate the percentage completed by dividing column G by column C. Column H: Enter here the difference between column C (Scheduled Value) and column G (Total Completed and Stored to Date). Column I: This column is normally used only for contracts where variable retainage is permitted on a line -item basis. It need not be completed on projects where a constant retainage is withheld from the overall contract amount. Change Orders: Although Change Orders could be incorporated by changing the schedule of values each time a Change Order is added to the Project, this is not normally done. Usually, Change Orders are listed separately, either on their own G703 form or at the end of the basic schedule. The amount of the original contract adjusted by Change Orders is to be entered in the appropriate location on the G702 /CMa form. Construction Change Directives: Amounts not in dispute that have been included in Construction Change Directives should be incorporated into one or more Change Orders. Amounts remaining in dispute should be dealt with according to Section 7.3 in A201 /CMa. E. Making Payment The Owner should make payment directly to the Contractor based on the amount certified by the Construction Manager and Architect on AIA Document G702/CMa, Application and Certificate for Payment, Construction Manager Adviser Edition. The completed form contains the name and address of the Contractor. Payment should not be made to any other party unless specifically indicated on G702 /CMa. f. AIA Document G702 /CMaTM 1992. Copyright 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and international Treaties. Unauthorized reproduction or distribution of this At A Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. 2695 -4320 124070 I TM Document G703 —1992 ERMCO Contract Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION N0: 23 containing Contractors signed certification is attached. APPLICATION DATE: 3/15/2010 In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column I on.Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F' G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) (D E) D OR E) (D +E +F) (C G) 0.001 OBILIZATION 15,000.00 15,000.00 15,000.00 100 0.002 P.M. 200,000.00 158,374.00 4,625.00 162,999.00 81 37,001.00 0.003 AD ENG 80,000.00 80,000.00 80,000.00 100 0.004 EMP L 75,000.00 63,078.00 3,500.00 66,578.00 89 8,422.00 0.005 TEMP M 45,000.00 41,375.00 500.00 41,875.00 93 3,125.00 0.006 LEAN UP 15,000.00 9,120.00 500.00 9 64 5,380.00 0.007 BOND 72,000.00 72,000.00 72,400.00 100 0.008 FESTING 18,000.00 12,000.00 12 67 6,000.00 0.009 SITE :OFFICE;' 23,000.00 22,050.00 22,050.00 96 950.00 0.010 DEMOBILIZATION 5,000.00 5 ,000.00 0.011 ALLOWANCE 12 550,000.00 466,772.00 466,772.00 85 83,228.00 0.012 ALLOWNACE 13 350,000.00 131,309.16 10,235.40 141,544.56 40 208,455.44 0.013 ALLOWANCE 14 100,000.00 75,000.00 75,000.00 75 25,000.00 0.014 ALLOWANCE 15 5,000.00 5 ,000.00 5,000.00 100 o.oi5 0, LLOWANCE 16 10,000.00 10,000.00 10,000.00 100 0.016 0.11 0.017 VIAT 10,000.00 10,000.00 10.000.00 100 0.018 BOR 6,000.00 6,000.00 6,000.00 100 0.019 EXCAVATION 35,000.00 35,000.00 35,000.00 100 0.020 EO.12 0.025 BRANCH R M 500.00 500.00 500.00 100 0.026 BRANCH R L 1,500.00 1,500.00 1. 500.00 100 0.027 BRANCH F M 100.00 100.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1956, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorised reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten 0 0) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright @aia.org. TM ERMCO Contract 4� 2695 -4320 124070 Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION''NO`. 23 containing Contractor's:signed certification is attached. APPLICATION DATE: 3/15/2010 In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F G H WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINIS RATE) (D E) D OR E) (D +E +F) (C G) 0.028 3 RANCH F L 200.00 200.00 0.029 El .01 0.030 7 EEDER M 975,000.00 970,750.00 970,750.00 100 4,250.00 0.031 EEDER L 600,000.00 591,000.00 4,500.00 595,500.00 99': 4,500.00 0.032 1.02 0.033 Q M 250,000.00 246,000.00 246 98 4,000.00 0.034 Q L 150,000.00 140,000.00 3,500.00 143,500.00 96 6,500.00 0.035 1.03 0.036 Q R.;- M 10,000.00 8,500.00 1,500.00 10,000.00 100 0.037 Q" R L 15,000.00 12,500.00 2,000.00 14,500.00 97 500.00 0.038 -Q F -M 30,000.00 28,000.00 28,000.00 93 2,000.00 0.039 Q F L 8,000.00 5,000.00 5,000.00 63 3,000.00 0.040 =1.04 0.041 H Q R M 10,000.00 7,500.00 2,500.00 10,000.00 100 0.042 Q R L 15,000.00 7,500.00 5,000.00 12.500.00 83 2,500.00 0.043 F Q F M 25,000.00 20,000.00 1,500.00 21,500.00 86 3,500.00 0.044 E Q F L 8,000.00 3,000.00 3,000.00 6,000.00 75 2,000.00 0.045 1.05 0.046 Q R M 5,000.00 4,000.00 4,000.00 80 1,000.00 0.047 E Q R L 5,000.00 1 1 20 4,000.00 0.048 H Q F M 35,000.00 25,000.00 5,000.00 30,000.00 86 5,000.00 0.049 EQ F L 8,000.00 4,500.00 1,500.00 6;000.00 75 2,000.00 o.oso E 2.00 A P CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, ccpynght@)aia.org. Ei2INC0 Contract 2695 -4320 124070 TM Document.+�103 -1992 Continuation Sheet AIA Document G702 APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO: containing Contractor's signed certification is attached. 3/15/2010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column .1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B 7SCHEDULED PRESENTLY COMPLETED D E F' G H WORK COMPLETED MATERIALS TOTAL BALANCE OM PREVI OUS TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (iF VARIABLE NO PPLICATION THIS PERIOD (G C) FINISH (NOT IN TO DATE RATE) (D E) D OR E) (D +E +F) (C G) 0.051 RIGGING 35,000.00 35,000.00 35,000.00 100 0.052 Q R M 30,000.00 30,000.00 30,000.00 100 0.053 Q R L 20 18,000.00 18,000.00 90 2,000.00 0.054 M Q F M 575,000.00 570,000.00 570,000.00 90 5,000.00 0.055 EQ F L 30 25,000.00 25,000.00 83 5,000.00 0.056 BRANCH R M 17,000.00 15,350.00 1,650.00 17,00 100 0.057 BRANCH R L 13,000.00 9,800.00 L500.00 .11;300:00 87 1,700.00 0.058 RANCH F M 7,000.00 5,000.00 71 2,000.00 0.059 RANCH F' L 5,000.00 2,000.00 2,000.00 40 3,000.00 0.060 .EEDER R M 550,000.00 547,500.00 1,000.00 548,500.00 100 1,500.00 0.061 zEEDER R L 250,000.00 244.000.00 3 247,000.00 99 3,000.00 0.062 EEDER F M 6,000.00 3,500.00 1,500.00 5,000.00 83 1,000.00 0.063 EEDER F L 10,000.00 7 1,500.00 9,000.00 90 1,000.00 0.064 2.01 E2.02 0.065 IGGING 10, 000.00 10,000.00 10,000.00 100 0.070 RANCH R M 15,000.00 11,050.00 3,950.00 15.000.00 100 0.071 BRANCH R L 8,000.00 6,080.00 500.00 6,580.00 82 1,420.00 0.072 BRANCH F M 2.500.00 1,500.00 1,500.00 60 1,000.00 0.073 BRANCH F L 1500.00 1.000.00 1,000.00 29. 2,500.00 0.074 -2.03 A 0.075 BRANCH R M 20,000.00 15,400.00 2.500.00 17,900.00: 90 2,100.00 0.076 BRANCH R L 16,000.00 11.320.00 1.500.00 1 80 3,180.00 0.077 BRANCH F W 1,000.00 1,000.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIO Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten 00) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. 1 ERMCO Contract 2695 -4320 TM 124070 Document G703 —1992 Continuation Sheet ATA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPI_ICATION'NO: 23 containing Contractor's signed certification is attached. APPLICATION DATE: 3/15/2010 In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column .1 on Contracts where Variable retainage for line items may apply. :.PERIOD T0: ARCHITECT'S PROJECT NO: A B C D E F G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETALNAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (G =C) FINISH (D E) (NOT IN TO DATE (C G) RATE) D OR E) (D +E +F) 0.078 BRANCH F L 2,500.00 2,500.00 0.079 7 EEDER R M 65,000.00 62,300.00 1,500.00 63,800.00 98 1,200.00 0.080 7 EEDER R L 45,000.00 41,900.00 1,500.00 43,400.00 96 1,600.00 0.081 7 EEDER F M 2,500.00 1,000.00 1,000.00 40 1,500.00 6.082 F EEDER F L 5,000.00 1,000 -00 2,000.00 3,000.00 60 2,000.00 0.083 2.04 0.084 BRANCH R M 6,000.00 4,420.00 4;420.00 74 1,580.00 0 -085 BRANCH.. R L 8,000.00 4,160.00 1,500.00 5,660.00 71 2,340.00 0.086 BRANCH. F M 1,000.00 1,000.00 0.087 BRANCH F L 2,500.00 2,500.00 0.088 2.05 0.089 BRANCH R M 15,000.00 11,050.00 1,500.00 12,550.00 84 2,450.00 0.090 BRANCH R L 14,000.00 7,780.00 2,500.00 10,280.00 73 3,720.00 0.091 BRANCH F M 800.00 800.00 0.092 BRANCH F L 1,500.00 1,500.00 0.093 E2,06 0.094 BRANCH R M 4,000.00 1,030.00 1,030.00 26 2,970.00 0.095 BRANCH R L 6,000.00 3,000.00 3,000.00 50 3,000.00 0.096 BRANCH F M 600.00 600.00 0.097 BRANCH F L 1.200.00 1,200.00 0.098 2.07 0.099 BRANCH R M. 8,000.00 3,560.00 2,500.00 6,Q60.00,. 76 1,940.00 0.100 BRANCH R L 10,000.00 5,000.00 2,000.00 7;000:00 70 3,000.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963,-1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. 111 ERMCO Contract 2695 -4320 124070 AIA Document G703TM -1992 Continuation Sheet AIA Document 6702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO`. 23 containing Contractors signed certification is attached. 3/15/2010 APPLICAT_ ION DATE: In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F' G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE STORED AND STORED SCHEDULED FROM PREVIOUS TO ITEM DESCRIPTION OF WORK (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) (D E) D OR E) (D +E +F) (C G} 0.101 BRANCH F M 1,000.00 1,000.00 0.102 BRANCH F L 2,500.00 2,500.00 0.103 2.07A 0.104 BRANCH R M 15,000.00 7,550.00 3,500.00 11,050.00 74 3,950.00 0.105 BRANCH R L 20,000.00 10,000.00 5,000.00 15,000.00: 75 5,000.00 0.106 BRANCH F M 9,000.00 4,500.00 4,500.00 50 4,500.00 0.107 BRANCH F L 10,000.00 3,500.00 3:500:00 35 6,500.00 0.108 2.08 0.109 BRANCH R M 6,000.00 1,920.00 1000.00 3,920.00 65 2,080.00 o. i 10 BRANCH R L 8,000.00 4,000.00 1,500-00 5,500.00 69 2,500.00 0.111 BRANCH F M 2,000.00 2,000.00 0.1 I2 BRANCH F L 3,500.00 3,500.00 0.113 2.09 0.114 Q R M 8,000.00 7,000.00 500.00 7.500.00 94 500.00 0.115 E Q R L 10,000.00 7,500.00 1,000.00 8,500.00 85 1,500.00 0.11.6 E Q F M 2,500.00 2,500.00 2,500.00 100 0.117 Q F L 3,000.00 1,500.00 1,500.00 50 1,500.00 0.118 2.10 0.119 BRANCH R M 1,000.00 1,000.00 1,000.00 100: 0.120 BRANCH R L 2,500.00 1,000.00 1,000.00 40 1,500.00 0.121 BRANCH F M 100.00 100.00 0.122 BRANCH F L 500.00 500.00 0.123 Q R M 6,000.00 3500.00 3:500:00 58 2,500.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Insikute of Architects' legal counsel, copyright @aia.org. ERMCO Contract 2695 -4320 TM 124070 Document G703 -1992 w� Continuation Sheet AIA Document G702 APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATION NO': 23 containing Contractors signed certification is attached. 3/15/2010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column I on,Contracts where variable retainage for line items may apply. PERIOD TO: AR CHITECT'S PROJECT NO: A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE PRESENTLY COMPLETED RETAINAGE SCHEDULED FROM PREVIOUS %n TO ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C) FINISH RATE) (.D E) D OR E) (D +E +F) (C G) 0.124 MQ R L 10,000.00 2,500.00 2,500.00 25 7,500.00 0.125 EQ F M 1,500.00 1,500.00 0.126 Q F L 2,000.00 2,000.00 0.162 4.00 &A &P 0.163 SOUND R M 75,000.00 69 2,500.00 72,000.00 96 3,000.00 0.164 SOUND R L 60,000.00 52,500.00 3,500.00 56.000 00 93 4 0.165 4.01 A 0.166 SOUND R M 40,000.00 31,000.00 4,500.00 35,500.00 89 4,500.00 0.167 OUND R L 25,000.00 21,500.00 1,500.00 23,000.00 92 2,000.00 0.168 4.02 A 0.169 SOUND R M 40,000.00 13,300.00 15 28,300.00 71 11,700.00 0.170 SOUND R L 25,000.00 7,500.00 5.000.00 12,500.00 50 12,500.00 0.171 4.03 0.172 SOUND R M 25,000.00 18,500.00 3,000.00 21,500.00 86 3,500.00 0.173 SOUND R L 18,000.00 9.400.00 1,500.00 10,900.00 61 7,100.00 0.174 4.04 0.175 SOUND R M 25.000.00 1%000.00 3,000.00 22,000.00 88 3 0.176 SOUND R L 18,000.00 15,000.00 1,000.00 16,000.00 89 2 0.177 E4.05 &.06 &.07 &.09 0.178 SOUND R M 80 66,100.00 66,100.00 83 13,900.00 0.179 SOUND R L 65,000.00 47,000.00 5,000.00 52,000.00' 80 13,000.00 0.180 P 0.181 A. R; -.M 15,000.00 8.750.00 3,500.00 12;250:00 82 2,750.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright @aia.org. ERMCO Contract 2695 -4320 124070 AIA Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO: 23 containing Contractor's signed certification is attached. 3/15/2010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column 1 on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S PROJECT NO: A E 7SCHEDULED PRESENTLY COMPLETED D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE OM PREVI OUS TO RETAINAGE ITEM DESCRIPTION QF WORK STORED AND STORED (IF VARIABLE NO. PPLICATION THIS PERIOD (G C) FINISH (D E) (NOT TN TO DATE (C G} RATE) D OR E) (D +E +F) 0.182 .A. R L 9,000.00 7,000.00 500.00 7 83 1,500.00 0.183 7 .A. F M 20,000.00 15,000.00 15,000.00 75 5,000.00 0.184 .A. F L 5,000.00 5,000.00 0.185 5.01 &.02 &.03 0.186 .A. R M 17,000.00 11,340.00 3,500.00 14,840.00 87 2,160.00 0.187 7 .A. R L 10,000.00 4,500,00 1,500.00 6;000!00 60 4,000.00 0.188 .A. F M 20,000.00 15,000.00 15`000:00 75 5,000.00 0.189 7 .A. F L 5.000.00 5,000.00 0.190 5.04 &.05 &.06 0.191 A. R M 20,000.00 12,900.00 3,500.00 16,400.00 82 3,600.00 0.192 A R L 17,000.00 5,500.00 2,500.00 8,000.00 47 9,000.00 0.193 .A. F M 20,000.00 15,000.00 15,000.00 75 5,000.00 0.194 .A. F L 5 5,000.00 0.195 5.07 &.08 &.09 &.10 0.196 .A. R M 20,000.00 11,900.00 3,000.00 14,900.00 75 5,100.00 0.197 .A. R L 15,000.00 4,500.00 4,500.00 9,000.00 60 6,000.00 0.198 F.A. F M 16,000.00 11,000.00 11,000.00 69 5,000.00 0.199 .A. F L 3,000.00 3,000.00 0.200 6.02 0.201 E Q M 55,000.00 45,000.00 45,000.00 82 10,000.00 0.202 H Q L 20,000.00 20,000.00 0.203 7,ABLE M 35,000.00 30,000.00 30,000.00 86 5,000.00 0204 CABLE L 45,000.00 45,000.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM+ 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AlODocument is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aia.org. ERMCO Contract 2695 -4320 s TM 124070 Document G703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION'NO: 23 containing Contractor's signed certification is attached. APPLICATION DATE: 3/15/2010 In tabulations below, amounts are stated to the nearest dollar, 3/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD T0: ARCHITECT'S P ROJECT NO; A B C D E F G H 1 WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (CT C) FINISH RATE) (D E) D OR E-) (D +E +F) (C C 0.205 3R M 5,000.00 100.00 100.00 2 4,900.00 0.206 3R L 2,000.00 2,000.00 0.207 E6.03 0.208 SECURITY R M 40,000.00 800.00 800.00 2 39,200.00 0.209 SECURITY R L 20,000 -00 2,000.00 2,000.00 10 18,000.00 0.210 SECURITY F M 18,000.00 18,000.00 0.211 SECURITY F:- L 6,000.00 6,000.00 0.212 6.05 0.213 DIMMING M 60,000.00 54,000.00 54,000.00 90 6,000.00 0.214 DIMMING L 45,000.00 29,850.00 29,850.00 66 15,150.00 0.215 -6.06 0.216 DIPTIC SENSOR M 8,000.00 8,000.00 0.217 DPTIC SENSOR L 4,000.00 4,000.00 0.218 7.09 0.219 3 C M 100,000.00 92,500.00 92,500.00 93 7,500.00 0.220 3 C L 80,000.00 60,000.00 2,500.00 62,500.00 78 17,500.00 0.221 8.00 0,222 IGHTNING PRO M 42,000.00 27,300.00 27,300.00 65 14,700.00 0.223 IGHTNING PRO L 18,000.00 11,700.00 11,700.00 65. 6,300.00 0.224 ALLOWANCE 17 40,000.00 10,765.00 10,765.00 27 29,235.00 0.225 CHANGE ORDER #1 0.226 OCULUS ALTERNATE 1,000.00 500.00 500.00 1000.00 100 0.227 CHANGE ORDER #2 CAUTION You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM 1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA' Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten 0 0) copies of this document when completed. To report copyright violations of AIA Contract Documents, e -mail The American Institute of Architects' legal counsel, copyright@aja.org. TM ERMCO Contract 2695 -4320 124070 Document 0703 -1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT, APPLICATION NO`. 23 containing Contractors signed certification is attached. APPLICATION DATE: 3/15 /2010 In tabulations below, amounts are stated to the nearest dollar. ji 3/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: A B C D E F': G H I WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED RESENTLY COMPLETED TO RETAINAGE LED FROM PREVIOUS ITEM DESCRIPTION OF WORK STORED AND STORED (IF VARIABLE NO. VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G C} FINISH RATE) (D E) D OR E) (D +E +F) (C G) 0.228 ACHINELESS ELEVATOR 11,500.00 8,500.00 3,000.00 11,500.00 100 0.229 HANGE ORDER #3 0.230 RCP 4 (58,852.00) (58,852.00) (58,852.00) 100 0.231 HANGE ORDER #004 NO COAT 0.232 HANGE ORDER 005 0.233 SI -037, RCP 006, 23,177.00 16,500.00 3,000.00 19,50000 84 3,677.00 0.234 73HANGE ORDER 006 0.235 CP -011 (7,554.00) (7,554.00) (7,554.00) 100 0.236 73HANGF ORDER #007 0.237 A I' -038 18,732.00 14,500.00 2,000.00 16,500.00 88 2,232.00 0.238 CHANGE ORDER 008 0.239 ALLOWANCE 4320A ELEC GENET (350,000.00) (350,000.00) (350,000.00) 100 0.240 ALLOWANCE 4330A FIRE ALARM (75,000.00) (75,000.00) (75,000.00) 100 0241 ALLOWANCE 4330B FIRE /SECUR (5,000.00) (5,000.00) (5,000.00) 100 0.242 ALLOWANCE 4320D ELECTRICAL (10,000.00) (10,000.00) (10,000.00) 100 0243 BOND REDUCTION FOR ALLOW f (2,715.00) (2,715.00) (2,715.00) 100 0.244 CHANGE ORDER 009 0.245 WORK DIRECTIVE 4320 -001 NE 0.246 CHANGE ORDER 010 0.247 AS I- PAC -104 WATER HEATER A. 17,090.00 6,000.00 3,500.00 9,500.00 56 7,590.00 0.248 E3.03 0.249 LIGHTING R -M 30,000.00 21,600.00 3,500.00 25A0000 84 4,900.00 0.250 LIGHTING R L 35,000.00 18,000.00 6,500.00 24 :500`.00 70 10,500.00 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM —1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This AIA Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIA Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA contract Documents, e -mail The American fnstitute of Architects' legal counsel, copyright @aia.org. I m ERMC© Contract 262695-4320 124070 Document G7p3 �f 1992 Continuation Sheet AIA Document G702, APPLICATION AND CERTIFICATION FOR PAYMENT APPLICATIONNO'` 23 containing Contractor's signed certitication is attached. 3/15/2010 APPLICATION DATE: In tabulations below, amounts are stated to the nearest dollar. 3/31/2010 Use Column I on Contracts where variable retainage for line items may apply. PERIOD TO: ARCHITECT'S PROJECT NO: WORK COMPLETED MATERIALS TOTAL BALANCE SCHEDULED FROM PREVIOUS PRESENTLY COMPLETED TO RETAINAGE ITEM DESCRIPTION OF WORK. STORED AND STORED (IF VARIABLE NO VALUE APPLICATION THIS PERIOD (NOT IN TO DATE (G —1 C) FINISH RATE) (D E) D OR E) (D+E +'F) (C G) 0251 LIGHTING F -M 350.000.00 184,602.00 92,576.00 277,178.00 79 72,822.00 0.252 LIGHTING F L 22,000.00 5,000.00 5,000.00 23 17,000.00 7,067,378.00 5,656,784.16 216,460.40 92.576.00 5,965,820.56 84 1,101,557.44 CAUTION: You should sign an original AIA Contract Document, on which this text appears in RED. An original assures that changes will not be obscured. AIA Document G703TM —1992. Copyright 1963, 1965, 1966, 1967, 1970, 1978, 1983 and 1992 by The American Institute of Architects. All rights reserved. WARNING: This Ale Document is protected by U.S. Copyright Law and International Treaties. Unauthorized reproduction or distribution of this AIO Document, or any portion of it, may result in severe civil and criminal penalties, and will be prosecuted to the maximum extent possible under the law. Purchasers are permitted to reproduce ten (10) copies of this document when completed. To report copyright violations of AIA Contract Documents, e-mail The American Institute of Architects' legal counsel, copyright@aia,org. AFFIDAVIT AND WAIVER OF LIEN STATE OF INDIANA Final Partial X )SS: COUNTY OF MARION Rod Burton being duly sworn states that he is the Controller of ERMCO, INC. having contracted with City of Carmel (124070.020) to furnish certain materials and /or labor as follows: Electrical Installation for a project known as Parcel 7A Regional Performiniz Arts Center Interior Rough Construction Package P4 located in Carmel, IN and does further state: PARTIAL WAIVER: That the balance due from the owner is the sum of FIVE HUNDRED SIX THOUSAND NINE HUNDRED FIFTY SEVEN DOLLARS AND 93/100($506,957.93) X the receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Partial Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: FINAL WAIVER: That the final balance due from the owner is the sum of receipt of which is hereby acknowledged: or the payment of which has been promised as the sole consideration for this Affidavit and Final Waiver of Lien which is given to and for said amount, effective upon receipt of such payment: THEREFORE, the undersigned waives and releases unto Owner of said premises any and all lien and claim whatsoever on the above described property and improvements thereon on account of labor or material or both, furnished by the undersigned thereto, and further certifies that no other party has any claim or right to a lien on account of any work performed or material furnished to the undersigned for said project, and within the scope of this affidavit and waiver. ERMCO, INC. by Rod Burton Controller Witness my hand and notarial seal, this 19 day of March, 2010 Pow Notary Public My Commission Expires 12/19/2015 Lou Anne Puckett Notary Public- Printed Signature County of Residence: Marion Light fixtures stored off site THIS BILLING DATED' 3/15/2010 Type count Crenshaw lighting costs Type per each count Total Ship Feb Ship Mar Ship Apr F1 $28,750.00 10 $287,500.00 Mar RA $17,250.00 1 $17,250.00 Mar F1 B $17,020.00 2 $34,040.00 Mar F2 $34,500.00 2 $69,000.00 Apr F2A $30,434.00 4 $121,736.00 Apr F3 $52,900.00 2 $105,800.00 Apr F5 $920.00 100 $92,000.00 Feb F6 $1,725.00 10 $17,250.00 Feb F8 $1,725.00 32 $55,200.00 Feb F8A $1,495.00 11 $16,445.00 Feb F9 $414.00 257 $106,398.00 Apr F9A $322.00 12 $3,864.00 Apr F10 $437.00 32 $13,984.00 Apr F10A $437.00 130 $56,810.00 Apr F101VIOD $437.00 14 $6,118.00 Apr F14 $690.00 34 $23,460.00 Apr F18 $1,380.00 48 $66,240.00 A r F20 $1,495.00 64 $95,680.00 Feb F22 $862.00 28 $24,136.00 Apr FE1 $8,050.00 3 $24,150.00 A r FE3 $2,875.00 12 $34,500.00 Feb FE4 $1,150.00 16 $18,400.00 Feb FE5 $1,725.00 6 $10,350.00 Feb Total $1,300,311.00 $339,825.00 38,790.001 $555,456.00 $678,615.00 FACTORY MUTUAL INSURANCE COMPANY 540 Maryville Centre Suite 400 St. Louis, MO 63141 CERTIFICATE OF INSURANCE 314-453-9660 we hereby certify that insurance coverage is now in force with our Company as outlined below. This certificate does not amend, extend or alter the coverage afforded by the policy. TITLE OF INS URED: GRAYBAR ELECTRIC COMPANY, INC. ET Al., Policy No: FM Effective: 01- Jan -2010 Accoun No: 1- 1083 Expires: 01- Jan -2011 Descript Lo cation of Property Covered: Index No: 055525.22 Personal Property Ins Loc: E -07 Chicago Division: PP1 1300 West 16th Street INDIANAPOLIS, IN 462022112 COVERAG I N FORCE (Subject to limits of liability, deductibles and all conditions in the palicyl Insurance Provided: Peril: Limit of Liability: PROPERTY DAMAGE ALL RISK $755 ,000 ADDITIONAL IN (See Page 2) Additional interests under the policy, consisting of, but not limited to mortgagees, lenders loss payees, loss payees, and additional named insureds, are covered in accordance with Certificates of Insurance issued to such interests and on file with this Company. Loss, if any, shall be payable to such additional interests, as their interests may appear, and in accordance with loss payment provisions of the policy. Mailing: ATTN: TOM HUTSELL Certificate: 0013'1-001 SHIEL SEXTON COMPANY Effective Vie: 01- Tan -20 10 902 NORTH CAPTTOL IN.T)TANAPOTAS, IN 46204 BY Author;�,.� Id_5� -d ire /Date 1 of 2 TERRYQ4__T MA 30- Dec -2009 FACTORY MUTUAL INSURANCE COMPANY 540 Maryville Centre Suite 400 St. Louis, MO 63141 314- 453 -9660 CERTIFICATE OF INSURANCE We hereby certify that insurance coverage is now in force with our Company as outlined below. This certificate does not amend, extend or alter the coverage afforded by the po licy. TITLE OF IN SURED: GRAYEAR ELECTRIC COMPANY, INC. ET AL P No: FM057 Effective; an -2010 Acccsun No: 1 0S30 Eypires: 01-Jan ADDIT IONAL INTERESTS: Type Loss Payee: in accordance with the Additional interests clause stated. above. '':amp: ERM.0O INC:. Address ?.O. BOX 150 INDIANAPOLIS, TN 46202 aid Name: SHI.E.. SEXTON COMPAIVY Addresti. 902 NORTH CAPITOL INDIANAPOLIS, IN 462v4 and Name CITY OF CARME L RE DE.:VELOPVjE.'Tr COMMISSTON Address, ONE CIVIC SQUARE CARMEU, TN 46032 Personas Noperty consisting of: E:?lectrical. Fixtures for Carmel Regional Performing Arts Center 2 of 2 CERTIFIC'ATE: 0013'1 -001 DATE (MMIDDIYYYY) ACO CERTIFICATE OF LIABILITY INSURANCE 3/19/2010 PRODUCER (317) 853 -3500 FAX: (317) 853 -3501 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Pillar Group Risk Management, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE p g r HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 301 Pennsylvania Parkway ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Indianapolis IN 46280 INSURERS AFFORDING COVERAGE NAIC INSURED INSURER A. Ameri sure Insurance Co. ERMCO, Inc. INSURER B: Ameri sure Mutual Ins Co. P.O. Box 1507 INSURER C: INSURER D: Indianapolis IN 46206 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE L IMITS W N MAY H V D INSR I ADD'L TYPE OF INSURANCE POLICY NUMBER DATEYMMIODmE POLICY MMI �/Y LIMITS A GENERAL LIABILITY CPP2000197 12/31/2009 12/31/2010 EACH OCCURRENCE 5 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES occE ante 300,000 CLAIMS MADE FX OCCUR MED EXP An one arson 10 PERSONAL 8 ADV INJURY 1,000,000 GENERAL AGGREGATE 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOPAGG 2,000,000 POLICY X PEC LOC B AUTOMOBILE LIABILITY CA2000196 12/31/2009 12/31/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) X SCHEDULED AUTOS X HIRED AUTOS BODILY INJURY X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY EAACCIDENT ANY AUTO OTHER THAN EAACC AUTO ONLY: AGG B EXCESSIUMBRELLALIABILITY CU1312816 12/31/2009 12/31/2010 EACH OccUggENCE 10,000,000 X OCCUR CLAIMS MADE AGGREGATE 10,000,000 DEDUCTIBLE X RETENTION 0 B WORKERS COMPENSATION AND WC1082925 12/31/2009 12/31/2010 X ORY ICU- O7H- I ER EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTLVB E.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? E.L. DISEASE EA EMPLOYEE 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE- POLICY LIMIT 1,000,000 A OTHER Leased /Rented Equip CPP2000197 12/31/2009 12/31/2010 $5o,000 Per item $150,000 OCC A Installation Floater CPP2000197 12/31/2009 12/31/2010 $750,000 Per Loc $750,000 Max A Installation Floater CPP2000197 12/31/2009 12/31/2010 $750,000 Temp Loc $250,000Trans DESCRIPTION OF OPERATIONSILOCAT IONSIVEHICLESIEXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Project: Carmel Regional Performing Arts Center SEE ATTACHED NOTES See Blanket Additional Insured Endorsement *10 days notice for non payment of premium. Revised from Revised from 02/10/2010 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Shiel Sexton Company EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL ATTN Tom Hutsell *60 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 902 North Capitol FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE Indianapolis, IN 46204 INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Daniel Touw /JMH ACORD 25 (2001108) ACORD CORPORATION 1988 N QA') S ,n no., ❑ono I of IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108) IN5025 (oios).osa Page 2 of 2 COMMENTS/REMARKS Carmel Regional Performing Arts Center The Commercial General Liability and Automobile polices have been endorsed to add Shiel Sexton Company, Co., Inc., City of Carmel Redevelopment Commission, CSO Architects, L'Acquis Consulting Engineers and Lynch, Harrison Brumleve, Inc as Additional Insured. The Additional Insured endorsement includes Completed Operations for "your work The Commercial General Liability Policy is endorsed to the General Aggregate applies separately to each project. The Commercial General Liability Worker's Compensation and Automobile polices have been endorsed to include Waiver of Subrogation Endorsement in favor of Shiel Sexton Company, Inc. The Commercial General Liabiltiy Policy provided that the subcontractor s policies are Primary and Non Contributory for the work on Shiel Sexton Company, Inc. projects. The Commercial General Liability, Automobile Liability and Worker s Compensation policies have been endorsed to provide thirty (30) days notice of cancellation to Shiel Sexton Company, Inc. Installation. Floater includes coverage for Material Stored at Graybar Electric, 9222 Orly Road, Indianapolis, IN 46241 valued at approximately $555,456.00. Shiel Sexton Company is added as additional insured and loss payee with respect to stored material shown above. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. ERMCO, Inc. CPP2000197 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTOR'S BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM All of the terms, provisions, exclusions, and limitations of the coverage form apply except as specifically stated below. SECTION II WHO IS AN INSURED is amended to include as an insured any person or organization, called an additional insured in this endorsement: 1. Whom you are required to add as an additional insured on this policy under a written contract or agreement relating to your business; or 2. Who is named as an additional insured under this policy on a certificate of insurance. However, the written contract, agreement or certificate of insurance must require additional insured status for a time period during the term of this policy and be executed prior to the "bodily injury", "property damage "personal injury", or "advertising injury" giving rise to a claim under this policy. If, however, "your work" was commenced under a letter of intent or work order, subject to a subsequent reduction to writing within 30 days from such commencement and with customers whose customary contracts require they be named as additional insureds, we will provide additional insured status as specified in this endorsement. 3. If the additional insured is: (a) An individual, their spouse is also an additional insured. (b) A partnership or joint venture, members, partners, and their spouses are also additional insureds. (c) A limited liability company, members and managers are also additional insureds. (d) An organization other than a partnership, joint venture or limited liability company, executive officers and directors of the organization are also additional insureds. Stockholders are also additional insureds, but only with respect to their liability as stockholders. (e) A trust, you are an insured. Your trustees are also insureds, but only with respect to their duties as trustees. The insurance provided to the additional insured is limited as follows: 1. That person or organization is only an additional insured with respect to liability arising out of: (a) Premises you own, rent, lease, or occupy, or (b) Your ongoing operations performed for that additional insured, unless the written contract or agreement or the certificate of insurance requires "your work" coverage (or wording to the same effect) in which case the coverage provided shall extend to "your work" for that additional insured. Premises, as respects this provision, shall include common or public areas about such premises if so required in the written contract or agreement. Ongoing operations, as respects this provision, does not apply to "bodily injury" or "property damage' occurring after: (1) All work including materials, parts or equipment furnished in connection with such work on the project (other then service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or Includes copyrighted material of Insurance Services Office, Inc., with its permission. Copyright Insurance Services Office, Inc., 2003 CG 70 48 03 04 Page 1 of 2 (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 2. The limits of insurance applicable to the additional insured are the least of those specified in the written contract or agreement, or in the certificate of insurance or in the Declarations for this policy. If you also carry an Umbrella policy, and the written contract or agreement or certificate of insurance requires that the additional insured status also apply to such Umbrella policy, the limits of insurance applicable to the additional insured under this policy shall be those specified in the Declarations of this policy. The limits of insurance applicable to the additional insured are inclusive of and not in addition to the limits of insurance shown in the Declarations. 3. The additional insured status provided by this endorsement does not extend beyond the expiration or termination of a premises lease or rental agreement nor beyond the term of this policy. 4. Any person or organization who is an insured under the terms of this endorsement and who is also an insured under the terms of the GENERAL LIABILITY EXTENSION ENDORSEMENT, if attached to this policy, shall have the benefit of the terms of this endorsement if the terms of this endorsement are broader. 5. If a written contract or agreement or a certificate of insurance as outlined above requires that additional insured status be provided by the use of CG 20 10 11 85, then the terms of that endorsement, which are shown below, are incorporated into this endorsement as respects such additional insured, to the extent that such terms do not restrict coverage otherwise provided by this endorsement: ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS (FORM B) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART. SCHEDULE Name of Person or Organization: Blanket Where Required by Written Contract, Agreement, or Certificate of Insurance that the terms of CG 20 10 11 85 apply (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of "your work" for that insured by or for you. Copyright, Insurance Services Office, Inc., 1984 CG 20 10 11 85 The insurance provided to the additional insured does not apply to "bodily injury", "property damage "personal injury or "advertising injury" arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services including but not limited to: 1. The preparing, approving, or failing to prepare or approve maps, drawings, opinions, reports, surveys, change orders, design specifications; and 2. Supervisory, inspection, or engineering services. Any coverage provided in this endorsement is excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent, or on any other basis unless the written contract, agreement, or certificate of insurance requires that this insurance be primary, in which case this insurance will be primary without contribution from such other insurance available to the additional insured. Includes copyrighted material of Insurance Services Office, Inc., with Its permission. Copyright Insurance Services Office, Inc. 2003 Page 2of2 CG 70 48 03 04 Prescribed by State Board of Accounts ACCOUNTS PAYABLE VOUCHER City Form No. 264 (Rev. 1995) CITY OF CARMEL An invoice or bill to be properly itemized must show: kind of service, where performed, dates service rendered, by whom, rates per day, number of hours, rate per hour, number of units, price per unit, etc. Payee FrWy e v Purchase Order No. 1 ,9 6 7 6 "x 15 0 Terms IZ er `{G f�G Date Due 7 Invoice Invoice Description Amount Date Number (or note attached invoice(s) or bill(s)) Total 3 o C3� -yG I hereby certify that the attached invoice(s), or bill(s), is (are) true and correct and I have audited same in accordance with 1C 5- 11- 10 -1.6. 20 Clerk- Treasurer VOUCHER NO. WARRANT NO. ALLOWED 20 IN SUM OF ON ACCOUNT OF APPROPRIATION FOR Board Members PO# or INVO{CE NO. ACCT #/TITLE AMOUNT DEPT. I hereby certify that the attached invoice(s), or 3o9 0J 0- o bill(s) is (are) true and correct and that the materials or services itemized thereon for which charge is made were ordered and received except 20 %o Signature D; ectelof Red le pme t Tit Cost distribution ledger classification if claim paid motor vehicle highway fund